From the Guidelines
Inner ear infections, such as sudden sensorineural hearing loss (SSNHL), should be treated with corticosteroids as initial therapy, which may be given orally or through an injection through the eardrum (intratympanic), as they have been shown to potentially aid in hearing recovery. According to the clinical practice guideline on sudden hearing loss updated in 2019 1, many treatments have been proposed for SSNHL, but watchful waiting is an alternative to active treatment as between one-third and two-thirds of patients may recover hearing on their own. The guideline suggests that clinicians may offer corticosteroids as initial therapy, which is most commonly given in pill form but can be done with an injection through the eardrum for those patients for whom oral steroids are contraindicated.
Some key points to consider in the treatment and follow-up of inner ear infections include:
- The cause of SSNHL is often not readily apparent and thus called idiopathic, and it rarely affects both ears, but can be associated with other symptoms such as ringing (tinnitus), dizziness (vertigo), and fullness in the ear 1.
- The sudden change in hearing is obvious to the patient and should be evaluated as quickly as possible, with a comprehensive history, physical exam, and hearing test (audiogram) 1.
- Approximately one-third to two-thirds of patients with SSNHL may recover some percentage of their hearing within 2 weeks, and those who recover half of their hearing in the first 2 weeks have a better prognosis 1.
- Clinicians should offer salvage therapy (usually intratympanic steroids) for incomplete recovery after initial therapy, and the benefits of therapy may include more prompt and complete recovery of hearing, but there are also side effects that must be considered when choosing among the available options 1.
- Follow-up should occur within 6 months of initial diagnosis of SSNHL, with repeat audiometry to assess improvement 1.
In terms of specific treatment options, the guideline notes that antivirals are commonly prescribed, but there is insufficient evidence to support their effectiveness in treating sudden hearing loss, and hyperbaric oxygen may also be offered within 2 weeks of the initial diagnosis of SSNHL or up to 1 month in conjunction with steroids 1. However, the most recent and highest quality evidence suggests that corticosteroids should be the initial treatment of choice for SSNHL.
From the Research
Inner Ear Infection Treatment
- The treatment of inner ear infections can be managed in a clinic or may require admission or specialty consultation, depending on the severity of the infection 2, 3.
- Systemic delivery of medication is the foundation for treating inner ear diseases, but local delivery techniques are being developed to reduce systemic side effects 4.
- Medications such as azithromycin and amoxicillin may be used to treat inner ear infections, but their potential impact on hearing loss should be considered 5, 6.
Follow-up and Potential Complications
- Follow-up care is crucial to monitor the effectiveness of treatment and prevent potential complications, such as sensorineural hearing loss (SNHL) 5.
- The risk of SNHL associated with certain antibiotics, such as azithromycin and amoxicillin, should be assessed and monitored during follow-up care 5, 6.
- In some cases, hearing loss may resolve following the withdrawal of the suspected antibiotic, highlighting the importance of careful monitoring and follow-up care 6.